CBO Now Says Reform Cost Could Top $1 Trillion

WASHINGTON -- Spending not accounted for in its original estimates could bring the total price tag for the healthcare reform law to more than $1 trillion, according to the Congressional Budget Office.

The new projection accounts for at least $115 billion in additional discretionary spending over 10 years. In March, the CBO pegged the total cost of the bill at $940 billion.

The new estimates come largely from attaching cost figures to new grants and programs funded by the Patient Protection and Affordable Care Act (PPACA), including public health fellowships, rural physician training grants, elder abuse prevention programs, and Indian health programs.

The law specified one-year spending for a number of those programs, but left spending after that first year open ended. The newest estimate, released Tuesday, provides figures for those additional years, out to 2019.

Federal agencies, including the Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS), and the Centers for Medicare and Medicaid Services (CMS) will likely spend $10 billion to $20 billion over the next 10 years to implement the law, CBO director Doug Elmendorf said in a letter to Rep. Jerry Lewis (R-Calif.), who requested the revised estimate.

Republicans were quick to use the increased cost estimate as proof that the Obama administration wasn't honest about how much healthcare reform would cost.

"Before trying to 'sell' the new healthcare law, the Obama administration may want to be honest about how much it's going to cost American taxpayers," said House Republican Leader John Boehner of Ohio in a statement. "This new CBO analysis showing that the new healthcare law will cost at least $115 billion more than advertised provides ample cause for alarm."

However, just because the spending is authorized, doesn't mean Congress will actually spend the projected amount. Legislators could vote to spend more -- or less -- because discretionary spending is subject to the congressional appropriations process, Elmendorf explained in the letter.

"The law establishes a number of new programs and activities, as well as authorizing new funding for existing programs," Elmendorf wrote. "By their nature, however, all such potential effects on discretionary spending are subject to future appropriation actions, which could result in greater or smaller costs than the sums authorized by the legislation."

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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